Special Olympics swimming: positive effects on young people with Down syndrome

Purpose

The positive effects of sport and physical activity on health and well-being are worldwide recognized, while people with intellectual disabilities are often physically inactive. The aim of this study was to examine the perception of well-being, social integration, and emotional problems of Down syndrome (DS) subjects, who participated in Special Olympic (SO) training and competitions, and to investigate whether parents and their Down children have the same opinion on the problems caused by DS.

Methods

Ninety-three participants with DS were recruited for this study: 58 swimmers (aged 16.31 ± 1.55), 35 DS sedentary subjects (aged 16.06 ± 1.39), and their parents (n = 93). Two versions of the Strengths and Difficulties Questionnaires (SDQ) were individually administered: the Self-reported version (SDQ-SR), completed by the DS participants, and the Parental version (SDQ-P), completed by their parents.

Results

Results showed significant differences between sportive vs. non-sportive groups in the overall domain scores (p < 0.01), with better results for the sportive group. Parents of DS non-sportive participants underestimated their children problems in 6 of the 8 domains (p < 0.05).

Conclusions

Participation in SO competition can be recommended to improve general well-being perception and social skills in young individuals with DS.

     

Special concerns of the female athlete

The majority of injuries sustained by female athletes are due to participation in sports rather than their sex. Anatomic, hormonal,and functional differences should be understood when treating the female athlete. Screening should be done for eating disorders and the female athlete triad. Female athletes have increased rates of injury to the anterior cruciate ligament and patellofemoral disorders compared with their male counterparts.     

Special nutritional concerns for the female athlete

Inadequate dietary intake is the primary nutritional concern of today’s female athlete. As these athletes fail to consume enough energy to support the physical demands of training, they become at risk for disordered eating, amenorrhea, and osteoporosis, conditions collectively identified as the female athlete trial. This review addresses nutritional concerns of the female athlete, identification of those at risk, relationship of energy intake to menstrual irregularities, and recently identified chronic diseases associated with the female athlete triad. Strategies are offered to prevent harmful behaviors leading to the comorbidities associated with inadequate dietary intakes.     

Atlantooccipital instability in Down syndrome

Atlantooccipital instability is an uncommon and usually lethal result of major trauma. Nontraumatic cases of instability at this site are rare. We report the findings in two children with Down syndrome who have striking atlantooccipital subluxation demonstrated on flexion and extension radiographs. Since there is increasing radiologic evaluation of cervical spine stability in patients with Down syndrome who wish to participate in athletic activities, the status of the atlantooccipital joint needs careful assessment, especially after cervical fusion for C1-C2 instability.     

Posterior atlantooccipital subluxation in Down syndrome

Three Down syndrome patients with posterior atlantooccipital (AO) subluxation are described. All are asymptomatic. The subluxation becomes manifest during active extension of the neck and reduces in flexion. Methods of assessing posterior AO subluxation are discussed. The abnormality is attributed to ligamentous laxity in patients with Down syndrome.     

Forensic issues in Down syndrome fatalities

Down syndrome, or trisomy 21, is the most common chromosomal abnormality associated with intellectual impairment. Premature death is a feature of the syndrome due to a wide variety of conditions including congenital heart disease, impaired immune responses resulting in respiratory infections, acute leukaemia, upper airway narrowing, pulmonary hypertension, Alzheimer disease and atlantoaxial instability. Cases of Down syndrome not uncommonly present for medicolegal autopsy, as the non-specificity of symptoms and signs often precludes accurate antemortem establishment of a cause of death. Manifestations of Down syndrome are reviewed with an analysis of possible mechanisms of death and findings at autopsy.     

Down syndrome and sport participation

Individuals with Down syndrome (DS) derive measurable physiologic and psychologic benefits from participation in physical activities and sports. Physicians in the position of evaluating these individuals and providing guidance in regard to their competitive or recreational physical activities need to be aware of the physiologic and anatomic concerns specific to this population. Effective screening and evaluation by a physician, accompanied with clearly communicated guidelines for specific activities, can provide an individual with DS the opportunity to safely participate in sports and recreational physical activity.     

Premature aging in persons with Down syndrome: MR findings.

PURPOSETo determine whether persons with Down syndrome have features of premature aging on routine MR imaging sequences.METHODSSixty MR studies (in 30 persons with Down syndrome and 30 age- and sex-matched control subjects) were reviewed retrospectively by two blinded examiners. Sagittal T1-weighted and axial T2-weighted spin-echo images were evaluated for the presence and severity of three markers of brain aging: atrophy, white matter lesions, and T2 hypointensity of the basal ganglia, referenced to the examiner''s internal standard of normal for that age and sex.RESULTSPersons with Down syndrome had higher prevalence and severity of the three markers studied than the control subjects. Atrophy and white matter lesions increased in prevalence with age; abnormal T2 hypointensity of the basal ganglia was more equally distributed with age.CONCLUSIONPersons with Down syndrome have features of premature aging detectable at routine MR imaging.     

Atlantoaxial distance in patients with Down syndrome: standardization of measurement

Atlantoaxial subluxation is common in persons with Down syndrome. For radiologic screening to be valid, accurate measurement of the atlantoaxial distance (AAD) must be obtained from radiographs of the cervical spine. A radiopaque millimeter scale has been designed to simplify accurate measurement of the AAD from these radiographs.     

Joint stiffness and gait pattern evaluation in children with Down syndrome

Hypotonia, ligament laxity and motor alterations are characteristic for patients with Down syndrome (DS). The purpose of this study was the evaluation of typical gait pattern of subjects with Down syndrome and the quantification of their joint stiffness, connected with ligament laxity and hypotonia, as a possible compensation. 98 children with DS (mean age: 11.7 years; range: 6-15 years) and 30 healthy children (control group (CG); mean age: 11 years; range: 5-13 years) underwent full 3D gait analysis at self-selected speed. Subjects with DS walked with more hip flexion during the whole gait cycle, knee flexion in stance phase, a limitation of the knee range of motion, and plantarflexion of the ankle at initial contact. Ankle power was limited as evident in terminal stance and pre-swing, represented by a low propulsive capacity at push-off, too. Hip joint stiffness was increased in general in patients with DS versus normal subjects while ankle joint stiffness revealed a lower value instead.     

Moyamoya syndrome presenting in an adult with Down syndrome: A case report with a literature review

Moyamoya disease is an unusual occlusive cerebrovascular condition commonly seen in children, marked by stenosis of the internal carotid artery and circle of Willis, causing, cerebral ischemia. Moyamoya syndrome is a Moyamoya-like arteriopathy with risk factors including autoimmune disorders, thyroid disease, sickle cell disease, or Down syndrome. Trisomy 21 is a genetic disorder consistent with specific physical and behavioral characteristics, with intellectual impairment. We describe a rare case of Moyamoya syndrome manifesting as ischemic stroke in an adult with Down syndrome     

Knee joint kinematics of the pendulum test in children with and without Down syndrome

BackgroundThe Wartenberg pendulum test is a common clinical test that is used to measure stiffness about the knee in persons with and without disabilities such as cerebral palsy and Down syndrome (DS). Adults and adolescents with DS show fewer number of swing cycles and a lower relaxation index than healthy controls. However, it is not clear if children with DS show a similar trend compared to typically developing (TD) children.Research questionWas the knee joint kinematics different between children with and without DS during the pendulum test?MethodsThirteen children with DS and 13 TD children participated in this study. There were two load conditions: no load (NL) and with ankle load (AL) equal to 2 % of the subject’s body weight. Five trials of a pendulum test were collected for each condition.ResultsThe DS group showed a smaller first flexion excursion, a lower relaxation index, lower mean and peak velocities and accelerations during the first and second flexion and extension, and greater variability of acceleration during the first flexion than the TD group across both load conditions. This suggests that the DS group may have greater stiffness of the knee than the TD group to compensate for joint instability.SignificanceThe pendulum test appears to be a valid test to evaluate the passive stiffness of the knee in children with DS. The lower relaxation index in children with DS suggests that larger bursts of quadriceps may be activated during a pendulum test, particularly in the first flexion excursion, to assure the knee joint stability.     

Computed tomography of the upper cervical spine in Down syndrome

Axial CT of the upper cervical spine was performed on 25 Down syndrome patients. Measurements of the degree of atlantoaxial displacement, the sagittal diameters of the spinal canal and spinal cord, thickness of the transverse ligament, and the ratio of sagittal diameter of spinal cord to canal were made. Thirty-six percent of the group showed evidence of cord compression. These patients demonstrated a significant decrease in the anteroposterior diameter of the spinal canal and the cord with an increase in the degree of subluxation and the cord:canal ratio when compared with the remainder.     

Time and frequency analysis of the static balance in young adults with Down syndrome

The main objective of this study is to understand the differences in equilibrium control between normal subjects and those with Down syndrome. A total of 54 subjects participated voluntarily, divided into control group and Down syndrome group. The equilibrium of the subjects was tested under two conditions: bipedal support with eyes open and closed. The signals were analyzed in a time and frequency domain. The statistical parameters selected (i.e., RMS distance, mean velocity, mean frequency and sway area) to analyze the behavior of the center of pressures (CoP) are calculated employing the result of the combination of the time series data in both directions (i.e. resultant distance). In order to calculate the frequency bands produced by the displacements of the CoP, a Fast Fourier Transform of the data was performed. The group with Down syndrome showed poorer static equilibrium control than the control group in the time domain. In the frequency domain, we found differences between the groups in the distribution of energy in the frequency bands analyzed. In addition, we observed the existence of an interaction effect of the group and the condition tested (p<0.001). These findings show that in the absence of visual information, the control group increases the energy at low frequencies, while the group with Down syndrome decreases it. Additionally, the lower amount of energy observed in this band under the 'eyes closed' condition may serve to identify abnormalities in the functioning of the vestibular apparatus of individuals with Down syndrome and/or difficulties experienced by these individuals in extracting relevant information from this route.     

Brain atrophy in 18 patients with Down syndrome: a CT study

Individuals with Down syndrome develop neuropathologic and in some cases clinical evidence of Alzheimer disease after age 40. We compared CT scans of 18 Down syndrome subjects, 26-70 years old (seven of whom satisfied criteria for dementia), with 175 screened normal volunteer control subjects for evidence of cortical and subcortical atrophy. CT scans were analyzed as a function of age and cognitive status. The suprasellar cistern ratio, presumed to measure mesial temporal-lobe atrophy (or hypoplasia), was correlated with severity of cognitive impairment, even when age effects were removed. The suprasellar cistern ratio predicted dementia status with an accuracy of greater than 75%. Brain measurements on CT scans showed a distinct pattern of increased abnormality with age in patients with Down syndrome; this differed clearly from that seen in controls.     

Energetic optimization during over-ground walking in people with and without Down syndrome

Individuals with Down syndrome (DS) show reduced gait stability that may increase the metabolic rate (MR) during over-ground walking and alter their energetic cost per unit distance (EC(transport)) to speed relationship. If so, the preferred walking speed (PWS) of people with DS may coincide with their speed at minimal EC(transport), reflecting energetic optimization. This study therefore examined whether MR and EC(transport) during over-ground walking differ between individuals with and without DS and whether PWS minimizes their EC(transport). Expired gases were collected from 18 individuals with DS and 18 without during six over-ground walking trials, each lasting 6 min, at PWS and at 0.51, 0.76, 1.01, 1.26, and 1.51 m/s. Gross- and net-MR, and gross- and net-EC(transport) were expressed in dimensionless form. Energetically optimal walking speeds and minimal gross- and net-EC(transport) were determined from the gross- and net-EC(transport) to speed curves for each participant. Individuals with DS showed higher gross-MR, net-MR, gross-EC(transport), and net-EC(transport). PWS minimized gross-EC(transport) in participants with DS, but not in those without. PWS did not minimize net-EC(transport) in either group. Therefore, gross-EC(transport) minimization during over-ground walking may determine PWS when impairments alter the gross-EC(transport) to speed relationship.     

Step-rate thresholds for moderate and vigorous-intensity activity in persons with Down syndrome

ObjectivesMonitoring physical activity intensity in persons with Down syndrome (DS) may be affected by an altered relationship between metabolic equivalent units (METs) and step-rate. This study examined whether the relationship between METs and step-rate is altered in persons with DS and developed step-rate thresholds for activity intensity for these persons.DesignCross-sectional.MethodsEighteen persons with DS (25 ± 7 years; 8 women) and 22 persons without DS (26 ± 5 years; 9 women) completed six over-ground walking trials each lasting 6 min at their preferred speed and at 0.5, 0.75, 1.0, 1.25, and 1.5 m s^?1. METs were measured with portable spirometry and step-rate with hand-tally. Random effects models were used to predict METs from step-rate, squared step-rate, height, presence of DS, sex, and body mass index (BMI).ResultsStep-rate, squared step-rate, height, and presence of DS contributed significantly to the model (SE = 0.20 METs; R² = 0.63); sex and BMI did not contribute. As height increased, step-rate thresholds for moderate and vigorous-intensity activity decreased. For a given height, participants with DS had lower step-rate at the moderate-intensity threshold than participants without DS. Across participant heights, the moderate-intensity cut-off ranged between 101 and 76 steps min^?1 in persons with DS and between 103 and 80 steps min^?1 in persons without DS. For persons with DS, step-rate at the vigorous-intensity threshold ranged between 136 and 126 steps min^?1.ConclusionsPersons with DS showed altered relationship between METs and step-rate and had lower step-rate thresholds for moderate-intensity activity than persons without DS.     

Regular physical activity increases glutathione peroxidase activity in adolescents with Down syndrome.

OBJECTIVE: The present study was designed to determine the influence of a 12-week exercise program on the activity of erythrocyte glutathione peroxidase (GPX) in adolescents with Down syndrome. DESIGN: An interventional study with before-after comparison. SETTING: Sport Medicine School, University of Cadiz (Andalusia, Spain). PATIENTS: Thirty-one male adolescents (16.3+/-1.1) with Down syndrome. None of them suffered acute medical problems at that moment and had not taken part in any physical activity program in the last 6 months. INTERVENTION: A 12-week training program with 3 days per week, consisting of warm up (15 min) followed by a main part (20 to 35 min) at a work intensity of 60% to 75% of peak heart rate (HRmax=194.5-[0.56xage]) and by a cool-down period (10 min). MAIN OUTCOME MEASUREMENT: Erythrocyte activity of GPX. RESULTS: Preexercise and postexercise GPX activity in adolescents with Down syndrome were 24.8+/-3.1 [23.1 to 26.5] U/g hemoglobin and 29.3+/-2.9 [28.1 to 30.5] U/g hemoglobin, respectively. When compared with baseline values it was increased significantly (24.8+/-3.1 vs. 29.3+/-2.9; P=0.011). CONCLUSION: Regular exercise increased significantly GPX activity. Further studies are required to assess the behavior of other antioxidant enzymes to highlight potential benefits of regular exercise in redox metabolism.